ALLIANCE MEDICAL

We continued to provide high-quality care that is demonstrably responsive to patient needs even though COVID-19 significantly impacted the development of new quality programmes, including the integration of standardised quality metrics.

Alliance Medical’s quality assurance systems are based on the Group’s clinical quality and governance framework and are further supported by our QMS processes and accreditations. Accordingly:

• Alliance Medical was re-accredited in terms of the Royal College of Radiologists and College of Radiographers’ Quality Standard for Imaging (QSI) and remains the only multi-site provider in the UK with this accreditation. The Care Quality Commission rated 97% of our services as good (2019: 97%), and remained ISO  27001:2013 –  IT, NHS Digital Data Security and Protection Toolkit certified
• We are ISO 9001:2015 and ISO 2001:2015 certified in Italy
• Our Irish operations are Caspe Health Knowledge Systems (CHKS) and ISO 2001:2015 certified

Our team adapted all relevant clinical protocols and standard operating procedures in response to COVID-19. We operated in a new business-as-usual model within weeks. Our quality metrics and patient satisfaction results demonstrated that our services remained safe and of high quality during this transition. Furthermore, we completed COVID-19 secure risk assessments for all sites to ensure employees’ and patients’ safety. We continue publishing data and guidance on each country’s website to help patients prepare to visit our facilities.

One challenge we faced during the year was to continue providing assurance that our services complied with relevant legislation and guidelines. We could not conduct our internal audit site visits for a short period due to government-imposed restrictions. Instead, we conducted remote desktop reviews of site documentation and procedures. While the results of these audits were satisfactory, we recommenced site visits and reviews resume as soon as possible.

Patient satisfaction surveys continue to be an essential tool to gather feedback on our services. Our quality and risk teams monitor various metrics, which are reported against internal and contractual benchmarks. Metrics include patient experience, our patients’ propensity to recommend our services to their friends or family, and patients’ complaints.

Clinical quality indication	Year-on-year trend		Target		2020		2019
UK
Patient experience (satisfied and very satisfied)			>92.5%		97.3%		95.3%
Friends and family score			>92.5%		95.7%		94.9%
Written patient complaints per 10 000 scans			<5.0		1.9		3.2
Escalated events per 10 000 scans			1.0		0.9		0.9
CQR/IRMER incidents per 10 000 scans			0.0		0.1		0.1
RIDDOR reportable incidents per 10 000 scans			0.0		0.1		0.0
Clinical audit: Level 1 and 2 discretionary scores			<1.0%		0.14%		0.05%
IRELAND
Patient experience (satisfied and very satisfied)			>92.5%		96.0%		98.0%
Friends and family score			>92.5%		94.0%		96.5%
Written patient complaints per 10 000 scans			<6.0		3.0		4.2
ITALY
Patient experience (satisfied and very satisfied)			>80.0%		90.0%		88.0%
Friends and family score			>90.0%		87.0%		96.5%

We updated and relaunched our freedom to speak up (FTSU) framework. We appointed new FTSU champions to encourage our employees to report any concerns about our services or patient care. We focused on mandatory training to ensure our employees have the necessary skills to perform their duties.

The implementation of a radioisotope auto-dispenser system across our high-volume PET-CT units continues to significantly reduce our employees’ exposure to radiation. We installed the fully automatic Trasis Unidose dispensing system at four of our existing sites during the year. Going forward, all new site designs include the structural support and physical space for these dispensers which weigh over two tonnes each.

All countries set up command structures that oversaw our response to COVID-19, with daily and weekly conference calls with senior management and operational employees. Our quality and risk, and infection prevention and control teams also provided ongoing support and advice, and managed all clinical queries from patients.

SCANMED

We remain committed to achieving excellent clinical outcomes while meeting our patients’ needs. Scanmed made significant strides in clinical quality governance during the year. Among these, we implemented a new clinical governance committee structure based on our Group framework. We also appointed medical directors at each facility, who assumed responsibility for the safety and performance of their respective units.

Furthermore, we implemented the internal clinical governance audit methodology adopted by the Group. The methodology is built on a disciplined and systematic approach, and enables us to assess and improve the efficiency of operational management, risk management and internal controls.

Scanmed prepared for the re-accreditation of its outpatient clinics, Sport Klinika in Žory, and the Blachownia and St Raphael hospitals during the year. Pleasingly, the Blachownia Hospital was re-accredited by the Minister of Health. However, the inspections that form part of the remaining facilities’ re-accreditation process were delayed due to COVID-19. While our re-accreditation is voluntary, we believe that, once achieved, this will distinguish Scanmed in the Polish healthcare market in terms of quality and security of services.

The business has a well-functioning QMS verified through cyclical internal and external audits and is ISO 9001:2015 – QMS, ISO/IEC 27001:2017-06 – IT and ISO 31000:2009 – risk management certified. The business retained its ISO 9001:2015 QMS certification and was re-accredited in terms of ISO 27001:2017.

This year’s significant achievement was implementing unified, monthly quality reports and patient experience survey sacross Scanmed despite this not being a standard practice within Poland. We believe these are essential tools for improving the quality of care we provide to our patients, and will endeavour to increase our response rate going forward.

Indicator	Cardiology units		St Raphael Hospital		Blachownia Hospital		Sport Klinika
2020
Re-admissions (<30 days) (%)	0.81		1.37		1.90		0.39
Return to theatre (%)	0.78		0.57		0.64		0.66
Healthcare associated infections (%)	0.10		2.32		1.45		0.57
Pressure ulcers (%)	0.10		0.53		0.45		0.00
2019
Re-admissions (<30 days) (%)	0.62		2.72		1.86		0.26
Return to theatre (%)	1.15		0.60		0.43		0.52
Healthcare associated infections (%)	0.61		0.84		0.87		0.26
Pressure ulcers (%)	0.08		0.50		0.34		0.00

Infections increased due to a rise in acute admissions to St Raphael Hospital as the local academic hospital was repurposed to serve only COVID-19 patients. Therefore, the patient mix at St Raphael Hospital was dramatically different from the previous year.

Indicator	Year-on-year trend		2020		2019		2018
Healthcare associated infections (%)			1.32		0.67		0.84
Surgical site infections (%)			0.20		0.09		0.16
Ventilator associated pneumonia (%)			0.28		0.07		0.17
Central line associated bloodstream infections (%)			0.21		0.03		0.02
Catheter associated urinary tract infections (%)			0.28		0.12		0.08

In response to COVID-19, we rapidly developed and implemented procedures that complied with the guidelines of the Ministry of Health, Chief Sanitary Inspector and the NFZ. We continuously monitored these guidelines and updated our procedures accordingly. By leveraging our technological capabilities, we successfully implemented video and tele-consultations to protect employees and patients. We integrated these consultations with our system to enable electronic prescriptions and ordering of diagnostic tests. This ensured we could continue serving our patients during the COVID-19 pandemic at our outpatient units.

In the year ahead, we look forward to piloting a new, fully electronic system to maintain our medical records and ensure the reliable collection of key performance indicators.

OUR 2021 PRIORITIES
	ALLIANCE MEDICAL			SCANMED
Extending DoseWatch to the rest of our General Electric systems			Introducing completely electronic medical records within our hospital units
Further roll out and integration to NHS trusts			Implementing an effective electronic clinical reporting system to support the automated analyses and reporting of specific KPIs
Upgrading to a new, cloud-based Datix incident management system, and rolling it out to Ireland and Italy			Obtaining accreditation from the Minister of Health for our specialised clinics and primary healthcare at our medical units
Developing a standardised patient satisfaction survey across regions			Re-accreditation of St Raphael Hospital
Employee engagement and empowerment			Improving our patient satisfaction survey response rates